Keywords
diabetes mellitus
mortality
RAAS inhibitors
6-minute walk test
actigraphy
physical activity
How to Cite
Abstract
Abstract. One of the features of the coronavirus disease (COVID-19) caused by the SARS-CoV-2 coronavirus is the association between
the course of this infection and the presence of diabetes mellitus (DM). Inhibitors of the renin-angiotensin-aldosterone system (iRAAS) can increase the expression of angiotensin-converting enzyme 2 (ACE2). Since ACE2 is a functional receptor for SARS CoV-2, the question arose about the potential danger of iRAAS for patients with COVID-19.
The aim: to evaluate the outcomes of hospital treatment of COVID-19, taking into account the presence of DM and the use of iRAAS and risk factors for the development of DM in patients ods: analysis of medical archives regarding the treatment outcomes of inpatients with COVID-19 (n=1097) in the Municipal non-profit enterprise «Infectious Diseases Hospital of Kostyantynivka» (IDHK) and Kyiv Municipal Clinical Hospital №8 (KMCH) in 2021 (n=153, of which 28 people had DM). The results of 947 IDHK patients with COVID-19 and 150 patients with diabetes were analyzed at the time of hospitalization and treatment during their stay in the hospital. Contact was established with 93 individuals discharged from the KMCH in 2021, of which 32 signed informed consent and were examined in 2023-2024 (glucose tolerance test – GTT, anthropometric measurements, glycated hemoglobin (HbA1c), external respiratory function (FVC, FEV 1) and 6-minute walk test (6 MWT). Physical activity (PA) was assessed using a 7-day actigraphy and combined attachment loss (CAL) of teeth. 26 people without a history of severe COVID-19 served as a control group. Logistic regression analysis was used for statistical evaluations.
Results: mortality among patients with DM in the KMCH was higher than without DM: 20.0% vs. 12.4%, respectively (p=0.014), male gender, age, and fasting plasma glucose (FPG) were independently and positively associated with the risk of death in patients without DM, and iRAAS treatment with reduced risk: OR 0.22 (95% CI 0.07–0.72) taking into account age, gender and FPG. In the KMCH, the mortality of people with DM reached 53.6%, and in people without DM 12.8% (p<0.001), in COVID-19 patients with DM, the levels of C-reactive protein and D-dimer were higher than without DM. According to the survey (2023–2024) of 32 patients who recovered from the disease (2021), the proportions of new DM in the COVID-19 group and the control group did not differ. Age-standardized 6 МWT and MET’s were lower in COVID-19 survivors: 393.4 (76.9) m and 1.35 (0.23) versus 525.1 (76.9) m and 1.61 (0.26) in the controls. Correlation analysis in the COVID-19 group revealed positive correlation of patient age with systolic BP, CAL and a negative correlation with 6 МWT, МЕТ’s, PA, FEV 1, FVC, and in the control group – a positive correlation of age with НbА1с, CAL and confirmed a negative correlation with FEV 1, and FVC.
Conclusion: objective methods revealed lower PA and worse physical fitness 2 years after COVID-19, requiring hospital treatment. These results indicate an increased risk of developing DM2 in the near future. Development of PA monitoring programs for people who have suffered a severe form of COVID-19 should be the next task for preventive medicine. who have recovered from severe COVID-19. Material and meth-
References
Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020 Oct;36(7):e3319. doi: 10.1002/dmrr.3319.
Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld AL, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020 Jun;8(6):546-50. doi: 10.1016/S2213-8587(20)30152-2.
Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with Covid-19. N Engl J Med. 2020 Apr 23;382(17):1653-9. doi: 10.1056/NEJMsr2005760.
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020 Apr;8(4):e21. doi: 10.1016/S2213-2600(20)30116-8.
Javanmard SH, Heshmat-Ghahdarijani K, Vaseghi G. Angiotensin-converting-enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blocker (ARB) use in COVID-19 prevention or treatment: A paradox. Infect Control Hosp Epidemiol. 2021 Jan;42(1):118-9. doi: 10.1017/ice.2020.195.
Yang P, Wang N, Wang J, Luo A, Gao F, Tu Y. Admission fasting plasma glucose is an independent risk factor for 28-day mortality in patients with COVID-19. J Med Virol. 2021 Apr;93(4):2168-76. doi: 10.1002/jmv.26608.
Khalangot M, Sheichenko N, Gurianov V, Vlasenko V, Kurinna Y, Samson O, et al. Relationship between hyperglycemia, waist circumference, and the course of COVID-19: Mortality risk assessment. Experimental Biology and Medicine. 2021;246:1-7. doi: 10.1177/15353702211054452.
Міністерство охорони здоров’я України. Стандарти медичної допомоги «Коронавірусна хвороба (COVID-19)». [цитовано 2025 Чер 01]. Доступно: https://moz.gov.ua/uploads/3/19713-standarti_med_dopomogi_covid_19.pdf.
Khalangot M, Sheichenko N, Gurianov V, Zakharchenko T, Kravchenko V, Tronko M. RAAS inhibitors are associated with a better chance of surviving of inpatients with Covid-19 without a diagnosis of diabetes mellitus, compared with similar patients who did not require antihypertensive therapy or were treated with other antihypertensives. Front Endocrinol (Lausanne). 2023 Jan 19;14:1077959. doi: 10.3389/fendo.2023.1077959.
Kravchenko VI, Zakharchenko TF, Gurianov VG, Kovtun VA, Makarenko VA, Yakovenko OM, et al. Metabolic, anthropometric, and functional characteristics of individuals with severe COVID-19 nearly 20 months after recovery: low physical activity and cardiovascular endurance indicators. Endokrynologia. 2024;29(1):5-16. DOI: 10.31793/1680-1466.2024.29-1.5.